Bipolar Flashcards
Bipolar Disorder DSM 5 criteria
1 manic episode
-elevated, expansive, or irritable mood present for at 1 WEEK
-3 symptoms (4 if mood is only irritable)
D-distractibility
I-irresponsibility
G-grandiosity
F-flight of ideas
A-activity increased/psychomotor agitation
S- sleep need decreased
T-Talkativeness or pressured speech
Breakdown of bipolar stages
40% depression
5% manic
45% euthymic
What is the risk of suicide?
15-20X higher risk !
highest risk
Bipolar 2
major depressive episode + hypomania
Hypomania
3 of manic symptoms
for 4 days
-not so severe to cause marked impairment in functioning or require hospitalization
-NO psychosis (if there was psychosis it would be bipolar 1)
Cyclothymic disorder
2 years of minimum mood cycling but never meet enough criteria for bipolar 1 or 2 or major depressive disorder
Bipolar Unspecified
never meet full criteria
Men Vs women bipolar
equal
Genetics of Bipolar
Twins-75-85%
DZ twins-15-20%
1 parent-10%
2 parents 50%
Higher socioeconomic or lower bipolar
higher
which has a higher chance of becoming psychotic, bipolar or unipolar depression?
bipolar
What brain structure is enlarged in bipolar patients?
ventricles and increased white matter hyperintensities
What are some hints that a person might be bipolar when presenting with depression
- early onset (before 20)
- psychotic depression
- 1st episode is postpartum especially if psychotic
- recurrent depression with more than 5 episodes
- bipolar family history
- seasonal mood disorder
- atypical depression
- hypomania associated with antidepressants
- repeated loss of efficacy of antidepressants over time
10, trait mood liability, hyperthymic temperament - depression with mixed mood states
Suicidal ideation
I wish i were dead
the world would be a better place without me
-fleeting but can begin to persist on a daily basis
34% plan to attempt
Suicidal Intent
thoughts have moved to thinking how someone would commit
72% attempt to kill
Leading cause types of suicide
51% firearms
25% suffocation
17% poisoning
male suicide vs women
4: 1 commit men
3: 1 attempt female
Highest risk group for suicide?
- vets
- males
- middle aged
- elderly
- caucasians
- adolescents
Most serious risk factor listed first:
- currently has a feasible plan
- prior attempts
- psychosis
- high anxiety
- impulsivity
- presence of mental disorder
- substance abuse
- hopelessness
- lack of support
- family history of completed suicide
- significant neg event in last 3 months
- gun in the house
Are there low serotonin receptors and serotonin levels in CNS of suicides?
yes
Prevention of suicdie
Ask
Behavior incidents-details
Risk analysis
Remove means; make sure patient is safe
